Healthcare Provider Details

I. General information

NPI: 1548924814
Provider Name (Legal Business Name): MONIQUE THOMAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 MCCONNELL CT
MIDDLE RIVER MD
21220-3889
US

IV. Provider business mailing address

8109 HARFORD RD STE B
PARKVILLE MD
21234-9205
US

V. Phone/Fax

Practice location:
  • Phone: 410-336-4845
  • Fax:
Mailing address:
  • Phone: 443-539-3008
  • Fax: 443-539-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR209011
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: